Warren Charlotte E, Abuya Timothy, Kanya Lucy, Obare Francis, Njuki Rebecca, Temmerman Marleen, Bellows Ben
Population Council, 4301 Connecticut Avenue NW, Washington DC, 20008, USA.
Population Council General Accident Insurance House, Ralph Bunche Road, PO Box 17643, Nairobi, 00500, Kenya.
BMC Pregnancy Childbirth. 2015 Jul 24;15:153. doi: 10.1186/s12884-015-0588-y.
Health service fees constitute substantial barriers for women seeking childbirth and postnatal care. In an effort to reduce health inequities, the government of Kenya in 2006 introduced the output-based approach (OBA), or voucher programme, to increase poor women's access to quality Safe Motherhood services including postnatal care. To help improve service quality, OBA programmes purchase services on behalf of the poor and marginalised, with provider reimbursements for verified services. Kenya's programme accredited health facilities in three districts as well as in two informal Nairobi settlements.
Postnatal care quality in voucher health facilities (n = 21) accredited in 2006 and in similar non-voucher health facilities (n = 20) are compared with cross sectional data collected in 2010. Summary scores for quality were calculated as additive sums of specific aspects of each attribute (structure, process, outcome). Measures of effect were assessed in a linear regression model accounting for clustering at facility level. Data were analysed using Stata 11.0.
The overall quality of postnatal care is poor in voucher and non-voucher facilities, but many facilities demonstrated 'readiness' for postnatal care (structural attributes: infrastructure, equipment, supplies, staffing, training) indicated by high scores (83/111), with public voucher facilities scoring higher than public non-voucher facilities. The two groups of facilities evinced no significant differences in postnatal care mean process scores: 14.2/55 in voucher facilities versus 16.4/55 in non-voucher facilities; coefficient: -1.70 (-4.9, 1.5), p = 0.294. Significantly more newborns were seen within 48 hours (83.5% versus 72.1%: p = 0.001) and received Bacillus Calmette-Guerin (BCG) (82.5% versus 76.5%: p < 0.001) at voucher facilities than at non-voucher facilities.
Four years after facility accreditation in Kenya, scores for postnatal care quality are low in all facilities, even those with Safe Motherhood vouchers. We recommend the Kenya OBA programme review its Safe Motherhood reimbursement package and draw lessons from supply side results-based financing initiatives, to improve postnatal care quality.
医疗服务费用对寻求分娩和产后护理的妇女构成了重大障碍。为了减少健康不平等现象，肯尼亚政府于2006年引入了基于产出的方法（OBA），即代金券计划，以增加贫困妇女获得包括产后护理在内的优质安全孕产服务的机会。为了帮助提高服务质量，OBA计划代表贫困和边缘化群体购买服务，并向经过核实的服务的提供者报销费用。肯尼亚的该计划认可了三个地区以及内罗毕两个非正式定居点的医疗机构。
将2006年认可的代金券医疗机构（n = 21）和类似的非代金券医疗机构（n = 20）的产后护理质量与2010年收集的横断面数据进行比较。质量的汇总分数计算为每个属性（结构、过程、结果）的特定方面的累加和。在考虑机构层面聚类的线性回归模型中评估效应量。使用Stata 11.0分析数据。
代金券和非代金券医疗机构的产后护理总体质量较差，但许多机构在产后护理方面表现出“准备就绪”（结构属性：基础设施、设备、用品、人员配备、培训），得分较高（83/111），公立代金券医疗机构得分高于公立非代金券医疗机构。两组机构在产后护理平均过程得分上没有显著差异：代金券医疗机构为14.2/55，非代金券医疗机构为16.4/55；系数：-1.70（-4.9，1.5），p = 0.294。与非代金券医疗机构相比，代金券医疗机构在48小时内见到的新生儿明显更多（83.5%对72.1%：p = 0.001），并且接种卡介苗（BCG）的比例更高（82.5%对76.5%：p < 0.001）。
在肯尼亚医疗机构获得认可四年后，所有机构的产后护理质量得分都很低，即使是那些持有安全孕产代金券的机构。我们建议肯尼亚OBA计划审查其安全孕产报销方案，并从基于供应方结果的融资举措中吸取教训，以提高产后护理质量。
